South African Journal of Surgery - Volume 50, Issue 1, 2012
Volume 50, Issue 1, 2012
Short-term surgical missions : joining hands with local providers to ensure sustainability : opinionSource: South African Journal of Surgery 50 (2012)More Less
Short-term surgical missions may appear to fill a void in surgical capacity in the developing world, but may inadvertently also disrupt well-established local healthcare systems. The surgical providers of an East African hospital developed suggestions for improving these missions so that they can benefit visitors, local providers and patients alike.
Source: South African Journal of Surgery 50, pp 3 –5 (2012)More Less
Background. Well-organised and efficient prehospital transport is associated with an improved outcome in trauma patients. In Nigeria there is a paucity of information on prehospital transport of spinal cord-injured patients and its relation to mortality.
Objective. To determine whether prehospital transportation is a predictor of mortality in spinal cord-injured patients in Nigeria.
Design. Prospective cohort study.
Methods. Prehospital transport-related conditions, injury-to-arrival intervals and persons who brought spinal cord-injured patients to the casualty departments at the University of Abuja Teaching Hospital, Gwagwalada, and the National Orthopaedic Hospital, Lagos, were noted. Data were analysed using descriptive statistics, the chi-square test and multiple logistic regressions.
Main outcome measures. Mortality within 6 weeks of admission.
Results. During the review period, 168 patients with spinal cord injury presented to the casualty departments. Most presented 24 hours or more after the injury (67.9%) and were brought to casualty by their relatives (58.3%). Saloon cars were the most common mode of transportation (54.2%), most patients (55.4%) lying on their back during transfer. The majority of the patients (75%) had been taken to at least one other hospital before arriving at our casualty departments. The mortality rate was 16.7%. Multivariate analysis after adjusting for age, gender and means of transportation revealed that age (odds ratio (OR) 63.41, 95% confidence interval (CI) 9.24 - 43.53), a crouched position during transfer (OR 23.52, 95% CI 7.26 - 74.53), presentation after 24 hours (OR 5.48, 95% CI 3.20 - 16.42) and multiple hospital presentations (OR 7.94, 95% CI 1.89 - 33.43) were associated with death within 6 weeks of admission.
Conclusion. Well-organised and efficient prehospital transport would reduce mortality in spinal cord-injured patients. Providing information on prehospital transport would also reduce mortality.
Sacral pressure sore reconstruction - the pedicled superior gluteal artery perforator flap : general surgerySource: South African Journal of Surgery 50, pp 6 –8 (2012)More Less
Objective. To report the use of the pedicled superior gluteal artery perforator (SGAP) fasciocutaneous flap as a reliable surgical option for sacral pressure sore reconstruction.
Methods. A prospective study was conducted between September 2008 and September 2010 of 10 patients with stage 3 or 4 sacral pressure sores treated with a unilateral pedicled SGAP flap.
Results. All flaps survived completely with no complications in 9 patients. One patient had a haematoma below the flap that was easily drained. No recurrence of the bedsore occurred during follow-up.
Conclusion. We suggest that the pedicled SGAP fasciocutaneous flap is a reliable surgical option for sacral pressure sore reconstruction.
Source: South African Journal of Surgery 50, pp 9 –15 (2012)More Less
Objective. Little has been published regarding long-term surgical outcome after the initial management of acute sigmoid colon volvulus.
Methods. Patients undergoing primary resection and anastomosis (PRA) or Hartmann's procedure (HP) for sigmoid volvulus between September 1992 and August 2000 were reviewed. Eligible patients who had had the initial procedure at least 5 years previously were contacted and completed a questionnaire regarding recurrence, current symptoms and bowel habits.
Results. Data on 42 PRA patients and 36 HP patients were analysed. Follow-up (mean 7.2 years, range 5 - 11 years) was completed for 63 patients (37 PRA, 26 HP). Restoration of bowel continuity was successfully performed in 25 of 26 HP patients. No patient had megacolon. Constipation was reported by 83% of PRA and 65% of HP patients. Of these patients, 51% regularly used laxatives. No patient complained of incontinence, and no recurrences of sigmoid volvulus were recorded during the follow-up period.
Conclusion. Sigmoidectomy with primary anastomosis is a good option for the definitive management of sigmoid volvulus. Despite the high constipation rate, no recurrence occurred during long-term follow-up.
Source: South African Journal of Surgery 50, pp 16 –19 (2012)More Less
Background. Fournier's gangrene is a necrotising fasciitis of the genitalia and perineum, with associated polymicrobial infection and risk of organ failure or death. The purpose of this study was to determine the presentation, systemic and local predisposing factors, management challenges and outcome in south-eastern Nigeria.
Patients and methods. We studied 28 out of 34 consecutive male patients with complete case notes seen in two centres (the University of Nigeria Teaching Hospital and St Mary's Hospital) between January 1995 and December 2008. Operating theatre registers and urology ward admission registers were used to identify patients.
Results. The mean patient age was 48.3 years (range 28 - 66 years), with a peak age incidence of 50 - 59 years. The majority of patients were farmers, manual labourers and artisans. The site of gangrene was scrotal in 22 patients (78.6%), penoscrotal in 3 (10.7%), abdominoscrotal in 2 (7.1%) and scroto-perianal in 1 (3.6%). The mean interval between onset of symptoms and presentation was 7.2 days (range 3 - 14 days). Systemic predisposing factors identified were diabetes mellitus in 6 patients (21.4%), filariasis in 2 (7.2%), congestive cardiac failure in 1 (3.6%) and HIV infection in 1 (3.6%). In 18 patients (64.3%) no systemic factor was identified. Local predisposing factors identified were chronic scrotal skin itching in 16 patients (57.1%), scrotal thorn injury in 2 (7.1%) and urethral catheterisation in 2 (7.1%). Scrotal carbuncle and scrotal surgery each accounted for 2 patients (7.1%), and zipper injury and ischiorectal abscess occurred in 1 patient each (3.6%). No local predisposing factor was identified in 1 patient (3.6%). The common clinical features were fever, scrotal swelling / pain, and later a malodorous painless wound. Treatment involved fluid administration, correction of electrolyte imbalance, antibiotics, debridement and daily wound inspection / dressing with hydrogen peroxide soaks and sodium hypochlorite. The mean duration of hospital stay was 37.1.days (range 21 - 84 days). One patient died (3.6%).
Conclusion. Fournier's gangrene is a challenging surgical problem, with significant morbidity. Diabetes mellitus is a significant systemic risk factor. In the majority of our cases, no systemic predisposing factor was identified. Local risk factors, especially chronic scrotal itching, were contributory. With proper management, mortality is low.
Source: South African Journal of Surgery 50, pp 20 –21 (2012)More Less
Tigecycline, the first of a new class of broad-spectrum antibiotics (the glycylcyclines), has been licensed in South Africa for the parenteral treatment of adult patients with complicated intra-abdominal infections (cIAIs) and complicated skin and soft-tissue infections (cSSTIs).
Source: South African Journal of Surgery 50 (2012)More Less
A young child presented with intermittent bowel obstruction. The abdominal X-ray was not closely examined, and a contrast study was performed that demonstrated multiple tubular filling defects indicative of worms. The patient was treated accordingly. Reviewing the abdominal X-ray demonstrated numerous serpigenous, tubular, soft-tissue densities in gas-filled bowel loops.
Source: South African Journal of Surgery 50, pp 23 –24 (2012)More Less
A middle-aged man presented to the outpatient clinic, complaining of a 2-year history of abdominal pain. His attempts to seek assistance at the local clinic as well as 2 previous visits to our hospital had yielded no relief from the symptoms. He had undergone an exploratory laparotomy after a motor vehicle accident 3 years previously. Further questioning also revealed altered bowel habit.
For unknown reasons, the recommended imaging guidelines, which include plain radiographs and ultrasound as first-line investigations, were not requested, and the patient was referred for an abdomino-pelvic CT scan.